Provider Demographics
NPI:1417935263
Name:SHEWBRIDGE, RICHARD KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:KEVIN
Last Name:SHEWBRIDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2934 TOMPKINS RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9204
Mailing Address - Country:US
Mailing Address - Phone:330-723-2138
Mailing Address - Fax:
Practice Address - Street 1:4087 MEDINA RD
Practice Address - Street 2:SUITE 400
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-5946
Practice Address - Country:US
Practice Address - Phone:330-725-3713
Practice Address - Fax:330-725-2141
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069897207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0269687Medicaid
OHSH0805891Medicare ID - Type Unspecified
OH0269687Medicaid